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THE BACK
Applied Anatomy
1
INTRODUCTION
• The back, the
posterior aspect of
the trunk inferior
to the neck and
superior to the
gluteal region
(buttocks), is the
region of the body
to which the head,
neck, and limbs
are attached
...
• The vertebral column protects the spinal cord and
spinal nerves,
• supports the weight of the body superior to the level
of the pelvis,
• provides a partly rigid and flexible axis for the body
and a pivot for the head, and
• plays an important role in posture and locomotion
...
4
5
Curvatures of Vertebral Column
• The VC in adults has four
curvatures: cervical,
thoracic, lumbar, and
sacral
...
6
Curvatures of Vertebral Column
• The thoracic and
sacral curvatures
(kyphoses) are
concave anteriorly,
whereas the cervical
and lumbar
curvatures
(lordoses) are
concave posteriorly
...
Primary curvatures are
retained throughout life as
a consequence of
differences in height
between the anterior and
the posterior parts of the
vertebrae
...
• Secondary curvatures are maintained
primarily by differences in thickness between
the anterior and the posterior parts of the IV
discs
...
10
Abnormal curvatures of the vertebral
column
• (a) kyphosis (hunchback or humpback) an
abnormally increased thoracic curvature
resulting from osteoporosis; kyphosis occurs
in geriatric people of both sexes
...
To compensate for alterations
to their normal line of gravity, women develop
a temporary lordosis during late pregnancy
...
• Scoliosis is the most common deformity of the
vertebral column in pubertal girls (aged 12-15
years)
...
The lack of the posterior
spinous process allows for a greater range of
head extension
...
15
• The last cervical vertebra
C7 is also called the
vertebra prominens
...
• The ligamentum nuchae
(nuchal ligament)
attaches to cervical
spines
...
16
Cervical Fractures
• Fractures of the axis (C2)
often involve the dens and
are classified as types I, II,
and III
...
17
A Jefferson fracture is a burst fracture of the
atlas, often caused by a blow to the top of the
head
...
In
this fracture, the cruciform ligament is torn
and the spinal cord maybe crushed, causing
19
Sacrum
• Large, wedge-shaped bone,
which transmits body weight
to pelvis
• Five fused vertebrae, with
fusion complete by puberty
• Four pairs of sacral foramina
on dorsal and ventral (pelvic)
side
• Sacral hiatus, the opening of
sacral vertebral foramen
• The projecting anterior edge
of the body of the first sacral
vertebra is the sacral
promontory
...
In this case,
the spinal nerve roots may be pressed on,
causing low backache, sciatica, or a
shortened trunk
...
• Ankylosing spondylitis is a form of chronic
inflammatory arthritis, the most common of
which is rheumatoid arthritis, and causes pain,
stiffness, swelling, and limited motion in the
(lower) back
...
• It occurs when the front parts of the thoracic
vertebrae do not grow as fast as the back
parts and thus form a wedge shape, leading to
kyphosis
...
This bony defect is concealed by skin but its
location is often indicated by a tuft of hair
...
• Spina bifida cystica is associated with
herniation of the meninges (meningocele)
26
Spina Bifida
• Usually, neurological symptoms are present in
severe cases of meningomyelocele (e
...
,
paralysis of limbs and disturbances in bladder
and bowel control)
...
27
28
Low Back Pain
• Low back pain, the most common musculoskeletal
disorder, can have various causes
...
• Those causes identified most often include:
• •
Intervertebral disc rupture and herniation
• • erve inflammation or compression
N
• • egenerative changes in vertebral facet joints
D
29
Low Back Pain
•
•
•
•
•
•
Sacroiliac joint and ligament involvement
M
• etabolic bone disease
P
•sychosocial factors
A
• bdominal aneurysm
M
• etastatic cancer
M
• yofascial disorders
30
Dislocation of Vertebrae
• The bodies of the cervical vertebrae can be
dislocated in neck injuries with less force than
is required to fracture them
...
• When a cervical vertebra is severely
dislocated, it injures the spinal cord
...
• MRI may reveal the resulting soft tissue
damage
...
• In these types of hyperextension injuries, the
anterior longitudinal ligament is severely
stretched and may be torn
...
• It results in neck pain, stiff neck, and
headache and can be treated by supporting
the head and neck using a cervical collar that
is higher in the back than in the front; the
collar keeps the cervical vertebral column in a
flexed position
...
36
A herniated (slipped) disk
• It is a protrusion of the nucleus pulposus
through the annulus fibrosus of the
intervertebral disk into the intervertebral
foramen or into the vertebral canal,
compressing the spinal nerve root
...
37
Sciatica:
• It is characterized by pain radiating from the
back into the buttock and into the lower limb
and is most commonly caused by herniation of
a lower lumbar intervertebral disk
...
• is formed by the vertebral border of the
scapula, the superior border of the latissimus
dorsi and the lateral border of the trapezius
...
• lies superficial to the cardiac orifice of the
stomach on the left side
...
• is formed by the posterior border of the
external oblique, the superior border of the
iliac crest and the lateral border of the
40